Physical therapy can treat or improve vertigo

Stop spinning

Physical Therapist Kimberly Juge of Broomfield performs a lower back treatment on a patient for a vestibular disorder.
(
RACHEL WOOLF
)

One minute Bill Peterson was hauling logs on his shoulders through the forest, and the next minute he was so dizzy he could barely stand up.

"I couldn't look up or down. If I moved my head suddenly, things were spinning. If I got up from a chair, I had to count to 10 before I could move, and even then, it wouldn't always abate," said the Boulder man. "Lying down was like the worst hangover I'd ever had -- everything continually spinning. It didn't matter whether you closed your eyes or opened them."

He feared the worst. He didn't know how to escape the spinning. Several days later, as he walked slowly and cautiously the two blocks to a physical therapist's office, he says he was "pretty close to being in a vegetative state."

Ten minutes and three small adjustments later, Peterson was fine again. Just like that. He was shocked.

"I had no idea it was going to be that easy to remedy. No pills. No invasiveness of any kind. Just a little head adjustment," Peterson says.

Many people spend years suffering from some form of vertigo, treating it with pills and trips to the doctor, or just hoping it will go away -- not realizing that physical therapy can often quickly and easily solve the problem, according to Debra Layne, with North Boulder Physical Therapy, where Peterson was treated.

Although there are many different kinds of vertigo, as well as many different reasons it occurs, Layne says many people with vertigo can improve, if not alleviate, their symptoms through physical therapy.

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"Everyone thought for so long you couldn't do anything about it -- that it's just inside your head," she says.

But this is one health problem you might not have to live with, she says. And the good news is, these techniques are widely accepted and covered by Medicaid and insurance, she says.

About 5 to 10 percent of the population struggles with dizziness, vertigo and imbalance, and that number grows to as much as 40 percent for people over age 40. Some vertigo is central, or caused within the brain, and it can be connected with something serious, so physical therapists recommend a trip to the primary care physician as a first step. Other vertigo cases are peripheral, originating in the inner ear, or vestibular system.

The Mayo Clinic says dizziness is one of the most common reasons adults visit their doctors -- right up there with chest pain and fatigue.

So what happened to Bill Peterson?

Peterson experienced a sudden onset of Benign (harmless) Paroxysmal (comes and goes) Positional (occurs with position changes) Vertigo (the brain's perception that the world is moving around you or you're spinning in the world), the most common form of vertigo caused by a problem in the inner ear.

In Peterson's case, small "crystals" called otoliths that are usually suspended in gelatinous material inside the ear got loose, moving around in the ear canals and causing a sickening spinning feeling. His therapist determined this happened while he was volunteering mitigating the forest, bending over and picking up wood and stacking up piles of stash for eight hours in the heat.

"When people have a sudden onset of BPPV, it can be terrifying," Layne says.

She says she sometimes gets referrals from the ER from patients afraid they had a stroke or brain tumor.

Sometimes the vertigo starts after a virus in the inner ear or a sickness, such as a sinus infection, therapists say. Other times, the otoliths get knocked loose after a head injury, such as a concussion or car accident. Sometimes, no one knows why it happens, she says.

When Peterson arrived in Layne's office, she conducted an extensive review of his history and tested him with a specific maneuver. He sat on the bed with his legs in front of him. She brought his torso backward rapidly so his head was backward, and she turned his head in each direction. She noticed a specific kind of eye movement as his vertigo hit, indicating it was a case of BPPV.

She has to induce the vertigo to help it, she says.

Then she waits for it to fade. Then holds the head in position for 30 more seconds, while the otoliths come to rest. She repositions and moves the head in specific ways to essentially move the little crystals through various planes, collecting them all together and settling them back where they're supposed to be. Then she repeats the treatment again, and again.

She instructs patients to be careful not to shake up the otoliths while they're re-sticking to the membrane for the next day or so. That means no lying flat, exercising or even tilting your head back to drink.

Layne says 85 percent of her patients are better after one session.

The other 15 percent often re-disturb the otoliths by doing downward dog or not following instructions. Occasionally, stubborn otholiths need to be "vibrated" off with a vibrating machine during the maneuver.

Some websites and videos online teach how to do this technique, called the Epley Maneuver, at home, but physical therapist Petra Landfester, with Active Solutions Physical Therapy, doesn't recommend that. She says if you aren't careful, you might move the otoliths into a harder-to-treat canal, or injure your neck.

Occasionally, BPPV resolves on its own, Landfester says, but other times it can persist for years. She says she treated one client who felt off-balance for 21 years before she tried physical therapy.

"It ended up fixing the problem," Landfester says. But she then had to work on retraining her whole body what was the new normal, straight and midline.

What if it's not BPPV?

Occasionally, the vertigo's cause is beyond otoliths, but even in those cases, physical therapy can help, Layne says. Vertigo may be tied to a neck injury, and physical therapy can help relieve the stiffness and mobility that could be hampering the position-sense input from the neck to the brain. Treatments may include stretching, posture-training and strengthening exercises.

For patients with "visual vertigo," often caused by depth-perception problems, physical therapists can help clients practice eye tracking, Layne says.

Sometimes, the organs in the inner ear deteriorate with age or infection, resulting in permanent vertigo. In these cases, physical therapists help train patients to compensate by using their eyes more and improving balance, Layne says.

One of Kimberly Juge's clients at South Valley Physical Therapy in Boulder has a series of balancing and strengthening exercises that she practices at home, after she sustained multiple different injuries that have contributed to her vertigo.

"Part of what has to happen for good ear functioning, along with body awareness and balance, especially in walking or any kind of functional movement, is that your brain has to talk to your head and spine correctly," Juge says. "So if they're not in good alignment or giving you good awareness of where you are because of pain or tightness or restriction, what ends up happening is the ear doesn't get accurate information, so you feel off-balance."

Juge says most of her patients have additional issues beyond just the acute crystal problem, such as visual disruptions or somatic sensory issues, where they can't connect their head with their body.

"That's where we can come in and re-train that, whether it's an orthopedic issue or a balance issue," she says.

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